Medicare Review

Triage has a diverse portfolio of clients across all types of hospitals including large urban, academic, community, and rural. Leveraging this broad experience, Triage has developed a comprehensive review process to analyze both Inpatient and Outpatient Medicare claims data. Triage excels in identifying the root cause of Medicare variances, often stemming from cases where hospitals did not provide all the CMS required billing and coding information needed to receive the full reimbursement supported by account documentation. Our team consists of dedicated Medicare specialists certified in both CPT and ICD-10 coding who work closely with nationally recognized Medicare compliance experts to remain current on the latest CMS regulation changes that could impact reimbursement. The end result of these efforts is that Triage’s Medicare reviews have helped our clients recover significant revenue and address operational gaps to avoid future revenue loss.

Our reviews have uncovered underpayment risk in the following areas:

  • Incorrect Patient Discharge Status (Post-Acute Transfer)
  • Medicare Secondary Payer (MSP)
  • Charge Description Master Issues
  • Missing or Miscoded HCPCS
  • National Correct Coding Initiative (NCCI) Edits
  • Charge Capture
  • National and Local Coverage Determination Denials
  • DRG-Exempt Services
  • Denials for Incorrect or Incomplete Billing or Coding
  • Part A to Part B Rebilling (CMS-1599-F)